Students are arriving on college campuses with more mental health needs than ever before. Educators and mental health professionals share statistics and stories of increased anxiety, depression, self-harm, disordered eating, and suicidality. Many campuses are working hard to respond, researching the problem and offering new programs to support students. But, the often undiscussed problem is that every student transitioning into college has mental health needs that often go unmet.

Source: Sam Porter, used with permission

Over the past 8 years, we at Thinking Beyond Borders have been working with students in the college transition through our gap year programs. Our unique position outside the limitations of traditional higher education institutions allows us the opportunity to innovate solutions to meeting every student's needs. We’ve decided to share our approach to identifying and meeting late adolescent/early adult mental health needs in the hope of adding to the research of the problem and potential solutions for traditional colleges and universities.

It’s important to note that our programs are not designed to provide a therapeutic setting in which to address severe mental health challenges. Our mission is to empower and inspire students to address critical global issues. We developed the following approach not because it was our mission, but because our mission could not be pursued without also meeting these crucial student learning and growth needs.

Defining the Problem

The symptoms of student mental health needs described above are all too familiar to students, parents, and educators in secondary and higher education. Unfortunately, clear understanding of the causes of these symptoms is much harder to come by. Hara Estroff Marano’s post “Crisis U” points to a lack of resilience related to stress as a part of the puzzle. Vicki Abeles’ NY Times article identifies the competition for admissions to elite colleges as another factor. Julie Sceflo’s NY Times article highlights achievement focused parenting and social media in feeding an unhealthy pursuit of perfection. Dr. Madeline Levine points to the impact class privilege can have. Dr. Michael Kimmel illuminates the challenge some demographics face in shaping their masculine identity. At TBB, we’ve seen students struggle to shape their adult identities in a culture that raised them to define their worth by external measures including grades, test scores, college admissions, and extracurricular achievement. And, student mental health needs can also be caused by past or present trauma, biochemical imbalances, and genetics.

As if it needed to be harder, society then brings adolescents together at educational institutions in intense social environments dominated by peer relationships. In the case of college freshmen, this collection of students is largely 17-19 years old, entering a developmental stage where they generally push away their parents, rely heavily upon their peers for guidance, and engage in risk taking.

So, how do we define the problem of late adolescent/early adult mental health? At Thinking Beyond Borders, we assume every student has adjustment needs that are unique and dynamic. Given all of the above factors, it’s hard to imagine a student in the college transition who wouldn’t benefit from support in adjusting to adulthood, college, and the internal and external demands that can challenge one’s stability. Meeting those needs requires both a broad programmatic approach that reaches every student, and targeted support that identifies and addresses more specific needs.

Defining Success

We have two main goals that shape our approach to meeting the needs of our students:

Ensure immediate physical and emotional safety -- This requires accurate and timely identification of needs and issues, qualified personnel, and prompt planning and implementation of necessary interventions. It does not mean protecting students from stress, challenges, or failure.

Build skills and resilience for long term mental health -- This requires structured and qualified mentorship, individualized support, and tracking of learning and growth. It does not mean offering therapeutic interventions for every student, creating a clinical setting, or creating an introspective focus that detracts from academic studies.

For the sake of context, note that our one and two semester gap year programs are comprised of cohorts of up to 18 students and 3 Program Leaders. These intensive study abroad experiences include multi-country itineraries, cultural immersion through homestays and field based learning, and a rigorous academic curriculum. Within this context, students are generally exposed to greater physical and emotional stressors than they are used to at home.

Meeting the Common Needs of Students

As every student has adjustment needs, we offer structured support for all students in our core program design. Those supports include:

Experiences that establish resilience -- Driven in large part by the college admissions process, students are often defined by their achievements. Buttressed by the nature of social media, students are more expert in building a personal brand than developing a sense of self rooted in exploration of beliefs and passions. Students therefore need greater support in establishing their genuine adult identity by exploring their values and their respective relationships with the world. To do this, we challenge students to reflect on their core beliefs, interests, and talents while engaging with critical issues in the real world. Through this intensive process, they consider who they are and who they want to be. This clearer, internally rooted sense of self makes students more resilient when faced with setbacks and damages to their external brand.

Qualified and structured mentorship -- During this developmental moment when students are pushing away their parents and joining a community dominated by their peers, having a qualified mentor is crucial. Structured mentoring challenges students to set goals, reflect on their academic and social growth, and plan steps to take healthy risks to spur further growth. Less formal engagement develops trust that opens lines of communication and the ability to address topics adolescents often avoid discussing with adults for fear of facing discipline or judgement. We cannot stress enough the importance of having both highly qualified mentors and a structure that places them in the literal day to day of students’ lives. As such, all of our Program Leaders are Master’s level educators who see every student nearly every day of the program.

Peer support -- If adolescents are influenced by anyone, it’s their peers. We’ve created small peer groups that meet periodically throughout the program to provide a space for students to share challenges they are facing and support one another. While we have seen some groups foster a supportive and productive culture, others have floundered. We continue to experiment with ways of making these productive spaces.

Information on key wellness topics -- Starting with program orientation, we integrate curriculum that helps students reflect on their relationships with substances, how to maintain their physical and emotional well being, and factors related to personal identity. The latter of these, our “Who Am I?” seminars explore topics including sexual and gender identities, social class, and race and ethnicity. By reflecting in a supportive peer environment and with mentors, students develop a dynamic understanding of how these factors shape their lives and sense of self. Additionally, they identify processes and tools to find comfort and strength in their identity, and how to share it with others.

Distance from social media -- Every article above mentions the powerful and often negative influence of social media in the lives of students. By not allowing students to bring cell phones or other wifi enabled personal devices on the program, we have dramatically reduced the daily interaction with social media for many students. While they are certainly not completely without access (we provide a limited number of laptops for the students to share and internet cafés are abundant in most parts of the world we travel to), their exposure to the carefully planned posts of their peers looking perfect and happy are limited. We hear quite frequently from students how much they dread returning to their phones upon return to the US.

Meeting Specific Needs of Individuals

More complex mental health needs are crucial to identify and address before a crisis develops. We’ve integrated the following into our standard processes:

Information gathering and analysis to identify needs -- Over the years, it’s become abundantly clear that our biggest challenges aren’t the students (or at times, their parents) who report a history of mental health issues. Our biggest challenges are those who chose not to report their history. We have developed extensive means of gathering and analyzing information to help us identify needs. We start by making multiple appeals in varied formats for students and parents to disclose relevant history. This includes five separate appeals before departure, then continued opportunities once the student is on the program meeting regularly with mentors. Next, we train Program Leader teams to observe student behavior and debrief as a team on a daily basis. They track findings and concerns in weekly reports. These reports are shared with our US program staff who follow key concerns throughout the course of the program. This weekly reflection process and the perspective of “outsiders” to the program group assists in identifying concerning behavior patterns that point to unreported mental health needs. Finally, we create a culture within the cohort that pushes students to take responsibility for their peers, including reporting key health and safety concerns to Program Leaders. While it’s rare that students report entirely new concerns to Program Leaders, the information they provide often adds key details to the understanding the staff were developing of the student needs. In this sense we are not only helping to support those in immediate need, we are also teaching others in the group about how they can support those in their lives with mental health needs, and when they need to step back and seek support from those with a greater skills and experience.

Build and implement a plan -- We work as a team to develop and implement plans to support students with identified needs. The Program Leaders form the core of this team, with the US program administrators providing perspective and logistical support. More severe issues bring the expertise of our Psychological Consultant and CEO into the conversation to ensure we are bringing all available resources to the table. In some cases the students parents are also part of the equation. Our plans are shaped by three assumptions: 1) Each identified need represents an opportunity to support students in pursuing stronger mental health. 2) The best plans include a vision of success, with each step allowing for adaptation to new learning about the student’s needs. 3) We must know the limits of our capacity to meet mental health needs and exhaust every effort to get students to proper support.

Equip the team -- Our Program Leaders receive a full day of mental health training led by our Psychological Consultant before each program. They practice using a framework for categorizing and addressing mental health challenges. They have 24 hour access to the US program administrators. Our Psychological Consultant serves as an advisor to the entire team in both identifying potential challenges and plans. And, our Program Leader teams are equipped with the directive to inform the US program administrators when they feel the mental health needs of a student are beyond their ability to ensure the student’s health and safety. They are repeatedly informed that this is a crucial phrase because it triggers the removal of the student from the program and our efforts to support the family in finding appropriate services upon return to the US.

Learn from experience and adapt -- The weekly Program Leader reports, feedback collected from students about their experience, and post-program debriefs with our entire team help to capture the progress of individual students and our program development. By placing a strong emphasis on staff retention, particularly the US program administrators and Psychological Consultant, we have ensured institutional memory that allows each new program cycle to effectively add to the collective learnings of the programs that came before. The primary responsibility of every member of our team is to learn.

It’s safe to assume that every student in the college transition -- if not every late adolescent/early adult -- has adjustment needs. We know from experience that students and sometimes their parents can be “in denial” of mental health issues. We also have found that at times, they can be very good at concealing both serious and minor needs, either out of ignorance or to avoid stigma. Therefore, we believe it is crucial that our educational institutions, be they traditional schools or non-traditional organizations, strive to identify and meet the needs of every student, every day. We won’t always succeed in identifying and addressing needs, but we’re committed to looking for every opportunity to support students in pursuing stronger mental health. It may not be our institutional mission, but we can’t meet our mission without it.

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I think the problem is calling these needs "Mental Health Needs". That means to many that everone is "Sick". This is a stigma that shouldn't be there. Virtually everyone is depressed at some time or other. Does everyone have "Depression"; no.

Actually, I think the best solution for many kids is one or two years at a community college, probably while living at home for a time. Then, if it seems desirable to all parties, last two or three years at a "4-year" college. This spreads out and softens the life transitions, and is cheaper, too.

You make a great point about the stigma that comes with calling all of these challenges that late adolescents/early adults face "mental health needs". The stigma is real and problematic. But, I think the benefit of categorizing all of these as mental health needs is that it may help to remove the stigma because they are things that everyone experiences. Additionally, by labeling them this way, we call further attention for the need for intentional and meaningful efforts to meet those needs rather than to hope that students will simply find their way through the ups and downs on their own.

As for community college as an option, I agree that can be a great next step for students, both in terms of their transition to adulthood and their finances. But, I'd also point out that parents are not always well positioned to support students through this life transition and non-residential community colleges don't have the same opportunities and resources that 4 year campuses have.